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Referral details

Case 211990

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Referral category

Disease / syndrome / tumor / condition

Region of interest

right mandible

Referral reason

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Canaray 211990

1. Benign odontogenic cyst or cystic tumor associated with impacted tooth 48

A well-defined, corticated, unilocular radiolucency is continuous with the follicle of the horizontally impacted tooth 48. This radiolucency extends from the apical region of tooth 45 into the anterior border of the ramus and from the alveolar crest distal to tooth 47 to the inferior mandibular cortex. The contiguous buccal and lingual cortical plates are thinned and generally exhibit mild expansion. However, a prominent area of buccal expansion is apparent apical to teeth 46 and 47. A scalloping contour is noted along the endosteal surface of the mandible and adjacent to the roots of teeth 46 and 47. The root apices of teeth 46 and 47 demonstrate external resorption. Tooth 48 is inferiorly and slightly distally displaced to the level of the inferior mandibular border. The right mandibular nerve canal is deflected inferiorly and is compressed as a result of this pericoronal radiolucency.

These radiographic features are consistent with a benign odontogenic cyst or cystic tumor. The possibilities of an ameloblastoma or an odontogenic keratocyst should be considered. A biopsy and histopathologic evaluation are indicated for a definitive diagnosis.

Orthogonal measurements of pericoronal radiolucency associated with tooth 48

These orthogonal cross-sectional images demonstrate the approximate dimensions of the pericoronal radiolucency associated with tooth 48.

Right mandibular nerve lingual to tooth 48

The right mandibular nerve courses lingual to the coronal half of the distal root and to the cementoenamel junction of the crown of the horizontally impacted and inferiorly displaced tooth 48. Severe nerve compression is present. No signs of ankylosis are noted, but displacement of the impacted tooth 48 to the level of the inferior mandibular border suggests a potential risk of intraoperative mandibular fracture.

Axial views of posterior 4th quadrant

These axial cross-sectional images demonstrate the lingual passage of the right inferior alveolar nerve canal relative to tooth 48.

Mesiodistal views of posterior 4th quadrant

These mesiodistal cross-sectional images demonstrate the horizontal orientation of the impacted tooth 48. This tooth has been displaced by a large pericoronal radiolucency to the level of the inferior mandibular border.